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Medical Criteria for Degenerative Disc Disease

Dealing with a chronic health condition such as degenerative disc disease (DDD) can be extremely challenging. While life has permanently changed for you, the financial responsibilities of life do not go away.

The Social Security Disability Insurance Program (SSDI) was developed to assist people, such as yourself, who have become disabled due to a diagnosis such as degenerative disc disease.

To qualify for disability benefits with DDD, you'll need medical evidence that shows that you're unable to work for at least 12 months.

The Importance of the “Blue Book”

The SSA uses a medical guide, known as the Blue Book, to determine whether or not a condition such as DDD is severe enough to warrant disability payments. Many of the listings include information on the specific evidence required, such as clinical and laboratory tests.

It is of vital importance to work with your health care providers to ensure that you have completed all of the medical tests required by the SSA and that all of your medical evidence is in order.

Degenerative disc disease is a disorder of the spine that is listed in section 1.04 of the Blue Book.

To help you with the information gathering process, here is the most relevant medical evidence that you will need to provide to give you the best chance of being approved for SSDI.

How Disabling is Degenerative Disc Disease?

Evidence Needed Related to Your Degenerative Disc Disease Diagnosis

The first type of medical evidence that the Blue Book directly requests is a complete medical history of your DDD. You should be able to provide the following evidence:

  • Medical records from your physician are of vital importance. They should include your presenting symptoms, the history and progression of your disease, as well as the results of a full physical examination. Be certain that your doctor addresses the following in his notes:
    • Any pain that you experience in your arms or legs that is caused by compression of your nerve roots
    • Any signs or symptoms of radiculopathy, such as pain or tingling when you turn your head or use your hands
    • Any difficulty that you have with mobility due to pain, numbness or weakness
    • Any signs of symptoms of arachnoiditis such as severe stinging, shooting pain, muscle spasms, or twitching
    • Any bladder or bowel control problems you might have
    • Any required use of an assistive device, such as a walker, cane, or wheelchair
    • Any assistance that you require navigating stairs or getting in and out of a car due to pain, numbness or weakness
    • Your physician should perform and document the results of a straight leg raise test, both sitting and lying down.
  • If you have required surgery as a result of your DDD, your operative note and/or a pathology report should be included in your records.
  • Imaging results such as x-rays, MRIs or CT scans are of vital importance to provide related to your case

While any doctor can provide this information, the SSA gives more weight to the opinion of medical specialists. Therefore, if you are working with a neurologist, orthopedist, or surgeon, be certain to obtain records from these specialists.

Evidence Needed Related to Your Degenerative Disc Disease

The treatment for DDD varies from person to person. The SSA will need to know exactly what treatments you have received, your response to those treatments, and most importantly if your condition has worsened despite those treatments.

The Blue Book indicates that you need to have the above symptoms and that the symptoms must be unresponsive to medication for at least three consecutive months of treatment.

Be certain that your doctor has documented the following:

  • Any and all medications that you are receiving as a result of your DDD, as well as your response to the medications
  • Any injections that you require, such as steroids, as a result of your DDD
  • Any surgical procedures that have been performed including operative notes from the surgeon
  • Any physical therapy or other related therapies that you are getting to treat your disc disease

The Blue Book notes that not every patient will meet a particular qualifying condition’s listing, but you may unable to work with degenerative disc disease regardless. Information on your reactions and side effects to your treatments or medications are essential to provide to the SSA.

So long as you can prove that you are too ill to work due to complications that will persist for at least one year, you may still qualify for financial assistance.

Evidence Needed Related Your Quality of Life and Ability to Care for Yourself

Many people with DDD will not qualify for SSDI benefits through the Blue Book musculoskeletal listing. However, you still may be too ill to work. If this is the case, your doctor should provide physician notes documenting his or her opinion regarding your limitations and inability to function in life.

Your physician should carefully document your ability to take care of yourself, your home, and your activities of daily living.

The more specific that your doctor is about your limitations the better your chances are of being approved for disability benefits.

If you are suffering from symptoms related to your disc disease, and if you are unable to work due to limitations from your disease, you may still qualify for disability through a residual functioning capacity assessment.

Steps You Can Take to Win Your Disability Claim

If you haven’t applied yet, or if you have applied and were denied, remember that medical evidence listed in the Blue Book is arguably the most important factor in your Social Security disability claim for degenerative disc disease.

The entire Blue Book is available online, and the section on spinal disorders is quite detailed, so you may want to review section 1.04 with your physician to determine what medical records you have on hand, and what may need to be supplemented to be approved.

You may need to contact the medical records office at your hospital to obtain some of this information.

While you don’t need to provide medical documentation to the SSA yourself, it is helpful to be as organized as possible. When you visit your doctor, it is a good idea to present a written list of symptoms and side-effects that you are experiencing.

There are several ways that your neurologist, orthopedic doctor, or primary care physician can help including:

  • Ensuring that your full medical history related to your spine is up to date
  • Listing your past treatments and responses, as well as the plan for the future
  • Documenting all of your medications and experienced side effects

A Social Security disability attorney or advocate can assist you in ensuring that you claim for disability is thorough, thus increasing your chances for approval.

Consider a Free Evaluation with a Social Security advocate or attorney in your area today—Disability lawyers are only paid if you win your degenerative disc disease claim.